SECTION 4: SELF-CARE PRACTICES FOR PLANTAR FASCIITIS
applying ice works well following the self- massage with a ball described above. Exercise 6 This exercise is similar to Exercise 5; however, this exercise uses tools for self-massage instead of your hands. For this exercise, you will need a tennis ball, a golf ball, and a frozen bottle of water. Sit with bare feet. First, use the larger ball and then the smaller one to massage the sole of one foot, addressing all parts of the plantar fascia. Continue for one to two minutes with each ball. Note the differences in sensation between the larger and softer ball and the smaller, harder ball. Notice also what areas of the plantar fascia work better for each. Next, roll the frozen water bottle under the same foot for a few minutes, holding it on any areas that feel like they may need more time. Before using these tools on the other foot, get up and walk around the room. Do you notice a difference between the foot that was massaged and iced and the one that was not? What differences can you identify? Then, repeat the steps above on the other foot, walk around the room again, and make note of how your feet feel after both have received massage and ice. Having some first-hand experience with these techniques can be useful when instructing your clients how to use them to care for their own feet. Stretching The importance of stretching to relieve and prevent plantar fasciitis pain cannot be overstated, although it is an often- overlooked method of home treatment. Additionally, many athletes are guilty of not taking an adequate amount of time to stretch, if they stretch at all, after a workout. However, performing simple stretches consistently can make a significant difference in the reduction of plantar fasciitis episode durations, or in warding off a recurrence. Both passive stretching (in which areas of the body are stretched while at rest) and active stretching (in which muscles are engaged during stretching) can be beneficial. “Manual passive stretching/active stretching of the Achilles tendon and plantar fascia are the mainstay treatment for plantar fasciitis. Several studies have tested the efficacy of manual stretches with positive results” (Sharma and Singh, 2010). Manual passive stretches would include those in which the client manually stretches the foot, ankle, and toes in both directions from a seated position, allowing the foot and ankle to be at rest while all movement is created by the hands. Active stretching includes those for the calf muscles that might be performed directly following exercise, from both seated and standing positions. Easy stretches to demonstrate to clients would be the seated calf stretch with a towel around the foot as in Exercise 5 above, and standing calf stretches like dropping the heel off the bottom step of a flight of stairs or lunges near a wall. In cases of chronic plantar fasciitis, the combination of stretching both the foot and the calf muscles is ideal: The root of the problem may not necessarily lie in the foot itself but rather in the muscles that may be inhibiting dorsiflexion, as we have examined previously in this course. Taping In the absence of orthotics to treat plantar fasciitis, taping the foot can be an effective short-term measure to relieve symptoms for someone who cannot avoid spending time on their feet until the inflammation subsides. For this method, medical tape is used to create a band around the foot at the longitudinal arch in order to provide the arch with additional support and thus take some of the strain off the plantar fascia. There are many visual taping guidelines available online, using everything from basic first-aid tape to more professional kinesio and physical therapy tapes. Over-the-counter braces are also available in most pharmacies and can be used in place of tape. Although braces
There are some simple self-care methods that clients who suffer from plantar fasciitis can use at home, either at the first sign of symptoms to keep the inflammation from getting worse or between treatment sessions with a medical or massage professional to promote and accelerate the healing process. These tools can be useful if you yourself have recurring episodes of plantar fasciitis. They can also be suggested to your clients for at-home use if the client has been formally diagnosed with plantar fasciitis by a physician and after you have done a thorough assessment of their condition. Remember that we, as massage therapists, cannot diagnose conditions or give clients any information that could be misconstrued as a diagnosis. Clients should always be referred to a medical professional for a diagnosis. Self-massage Teaching your clients how to use a ball to massage their own plantar fascia at home can help them greatly reduce their symptoms. Keep a tennis ball, a racquetball, and a golf ball on hand at your office to demonstrate how to use them for self- massage. Which size ball they choose will be determined by the size of their feet and how intensely they want to massage them. Softer balls, like tennis balls, may be more appropriate at times when inflammation and pain are high; harder balls, like golf balls, may allow the user to add a little more pressure and target areas of the plantar fascia more specifically because of the smaller size. In a sitting position, they can place the ball under the affected foot and roll it along the plantar fascia to loosen the tissue in a gentle—but effective—way, letting their comfort level be their guide as to how much pressure to use and what areas might need more attention. A study published in the Journal of Acupuncture and Meridian Studies in 2018, which examined non-invasive and complementary methods for treating plantar fasciitis, indicated that the subject of the case study, a 43-year- old woman who was a recreational runner, saw improvement in her symptoms after following a self-care regimen that included self-massage with a ball. “To massage the plantar fascia, it was suggested the patient use a tennis ball and gently roll the bottom of her foot for 1–3 minutes before bed and prior to weight-bearing in the morning” (Lee and Marx, 2018). The timing of self-massage for the plantar fascia is also important. The best time to do this is first thing in the morning and last thing at night. Keeping a ball beside the bed so that self- massage can be performed in the morning before the foot becomes weight bearing can help ease the plantar fascia into the activity of the day. Repeating this protocol at the end of the day before going to bed can also help to loosen and unwind the fascia before a long period without bearing weight, which is when the plantar fascia tends to tighten up. Used in conjunction with ice (see below), self-massage can be very helpful in controlling inflammation and reducing the severity and duration of symptoms. Ice Ice is a frequently recommended treatment for many types of inflammation. It can be very useful for the treatment of plantar fasciitis, as well. Ice can temporarily reduce both pain and inflammation. When used frequently, it can shorten the duration of episodes of plantar fasciitis. An easy method to ice the plantar fascia on the sole of the foot is to freeze a plastic cup or bottle of water. Place the frozen bottle on the floor and roll it under the foot as needed to reduce pain and inflammation, adding both ice and light massage at the same time. It is generally recommended to use ice several times a day, for brief periods each time. The Mayo Clinic recommends the following ice protocol to treat plantar fasciitis: “Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes” (Mayo Clinic Staff, 2018). This method of
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